Determinants of anastomosis long term patency

Abstract

The hope of any surgeon performing vascular anastomosis is that the vascular reconstruction he is performing will last forever and patients will be once and for all set free from ischemic symptoms. Unfortunately, this rarely occurs mostly because the surgical procedure doesn’t treat the cause of vessel occlusion, such as the atherosclerosis and the atherosclerotic process will probably continue to progress, the anastomosis not being spared. Based on clinical experience, cardiac surgeons know, for instance, that to achieve 100% graft patency at 10 years they should use arterial grafts as conduits on a 3 mm coronary artery with proximal sub-occlusion, without distal disease, with large runoff in patients taking antiplatelet drugs and statins and no hypercoagulability (Fig. 1). On the other hand, 100% of graft occlusion at 10 days occurs when a large vein is anastomosed on 1 mm coronary artery with moderate proximal stenosis, with distal disease and poor runoff, in a diabetic patient taking no drugs. However, in this chapter, we systematically review the elements and parameters clearly affecting the outcome of any vascular reconstruction in order to give a general view of what cardiodiovascular surgeons should take into account in order to give a realistic expectation of anastomosis patency.